Sample Client Satisfaction Survey
CLIENT SATISFACTION QUESTIONNAIRE
Please help us improve our program by answering some questions about the services you have received. We are interested in your
honest opinion, whether they are positive or negative. Please answer all of the questions. We also welcome your comments and
suggestions on the bottom of this from. Thank you very much. We really appreciate your feedback.
Program: Immigration Legal Services_ Date: ____________ Age:_______ Male:______ Female:______
Please put a check on the line after the group that best describes your ethnicity.
Asian/Pacific Islander____ Biracial/Mixed_____ Black/African American_____ Hispanic/Latino_____
Native American _____White/Caucasian _____Other_____
1. The quality of the service I received was excellent
2. I got the kind of service I wanted.
3. The program met my needs.
4. If a friend were in need of similar help, I would
recommend this program to him or her.
5. I was satisfied with the amount of help I received
6. The services helped me to deal more effectively
with my problems.
7. In an overall sense, I was satisfied with the services
8. If I was to seek help again, I will come back to this
Please mail survey to Director of Catholic Charities at Address, City and State.